Many dentists would like to start treating snoring and sleep apnoea patients but don’t know where to start. Others hit barriers in making oral appliance therapy a significant part of their practice.
What is the first step in establishing a practice in dental sleep?
The first step is to start identifying the many patients you would have in your practice that have problems with snoring or sleep apnoea and would benefit significantly from an oral appliance.
Undiagnosed Sleep Apnoea
Over 80% of the population who have sleep apnoea don’t know they have it; a simple screening will uncover many patients that would otherwise remain undiagnosed.
Given the impact of snoring and sleep apnoea on people’s health and quality of life, this would be a valuable contribution to their well-being and is often life-changing.
Diagnosed Sleep Apnoea
There will be many patients in your practice who already have a sleep apnoea diagnosis but aren’t accessing treatment.
Many have been recommended the CPAP machine but have given up on it and don’t realise that there is a far more comfortable alternative that is just as effective for most people.
What is the best way of screening dental patients?
I recommend asking every single patient of the practice the following four questions:
- Do you snore regularly, and can your snoring disturb others sleeping close by?
- Do you tend to wake unrefreshed and be somewhat sleepy during the day?
- Has anyone seen or heard disturbances to your breathing while sleeping?
- Have you been diagnosed with obstructive sleep apnoea?
You could have a short preamble outlining dentists’ vital role in managing sleep disorders. I would include these questions in the medical history for every new patient, and I would also ask every patient who attends for treatment as part of a medical update.
Another questionnaire for screening is known as the “STOP-BANG”. The STOP-BANG has been validated in multiple settings and is an effective tool for screening the general population.
How would you recommend that the practice follows up with people identified as having problems with snoring and sleep apnoea?
Dental practices that implement oral appliance therapy will have a staff person trained to answer all the frequently asked questions. Such a person might be called a Sleep Coordinator and play an essential role in screening, motivating and educating patients. The practice needs to take the time to train a staff person for the role of sleep coordinator.
Once you identify the patients with sleep apnoea or possible sleep apnoea and are keen to proceed, what’s the next step?
It depends on which of the two categories the patient falls in.
1. There will be those already diagnosed with sleep apnoea and who are not accessing treatment. Patients already diagnosed with sleep apnoea will be good patients as they are already educated, obviously symptomatic and would be keen to get treatment. It is important to get hold of their sleep study and make sure that an oral appliance is recommended as a treatment option.
Dentists should only proceed with an oral appliance on the recommendation of a medically trained person.
As part of our training program, we have a template of emails that you can send to a sleep physician to get the go-ahead for making an oral appliance for a patient already diagnosed with sleep apnoea.
- If the patient hasn’t been diagnosed with sleep apnoea, you need to organise a sleep study.
Organising a sleep study has been the single most significant barrier for dentists wanting to work in the field. If you send the patient off to their GP, or a physician, the chances are great that you won’t see them again-they might be automatically offered CPAP, or their GP, not understanding too much about sleep apnoea, might tell them to simply lose weight.
Fortunately, there is now a simple system that dentists can use to organise sleep studies for their patients and get a recommendation from a sleep physician for an oral appliance for most of their patients. For more details, go to dentalsleepdiagnostics.com.au
by Dr Harry Ball
BDSc LDS (Melb) M Counsel. (Lat.) Grad Dip Counsell. & HS (La.)
Past co-chairperson dental sleep medicine council of the Australasian Sleep Association.
Co-Director SleepWise Clinic
For details of the next Dental Sleep Institute training program: “Oral Appliance therapy for Snoring Sleep Apnoea & Bruxism” visit the program page here.